Recurrent Challenges for Clinicians: Emergence of Methicillin-Resistant Staphylococcus aureus, Vancomycin Resistance, and Current Treatment Options.
Recurrent Challenges for Clinicians: Emergence of Methicillin-Resistant Staphylococcus aureus, Vancomycin Resistance, and Current Treatment Options.
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DOI：
10.4103/0974-2727.119843
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发表时间：
2013-07
影响因子：
1.1
通讯作者：
Kumar D
中科院分区：
文献类型：
--
作者：
Tarai B;Das P;Kumar D
革兰氏阳性病原体，主要是金黄色葡萄球菌、肠球菌和凝固酶阴性葡萄球菌，正在对糖肽产生越来越大的耐药性，这在治疗由这些病原体引起的感染中造成了问题。万古霉素是治疗耐甲氧西林链球菌的首选药物。金黄色葡萄球菌（MRSA）。社区获得性MRSA与近期无住院史且无MRSA携带经典危险因素的患者（包括医护人员）的感染相关。随着社区获得性MRSA的出现，MRSA在医院之外带来了新的威胁和挑战。万古霉素的滥用导致万古霉素耐药性在多药耐药菌株中的出现和传播，近年来受到越来越多的关注。最低抑菌浓度（MIC）仍然是选择正确抗生素的重要决定因素。万古霉素MIC > 4 μg/mL的MRSA菌株引起的感染导致万古霉素治疗失败。临床实验室标准研究所也降低了万古霉素的敏感性和耐药性临界点。尽管有新的抗微生物药物（利奈唑胺、达托霉素、替加环素）可用于耐药革兰氏阳性病原体，但临床医生和患者仍需要治疗MRSA感染的选择。需要减少由革兰氏阳性病原体及其耐药菌株（主要是MRSA）引起的全球感染负担。应通过早期发现耐药菌株和在医院环境中使用适当的感染控制措施，不断努力防止糖肽耐药的传播和出现。
Gram-positive pathogens mainly, Staphylococcus aureus, Enterococcus and coagulase-negative Staphylococcus, are developing increasing resistance to glycopeptides that pose a problem in treating infections caused by these pathogens. Vancomycin is the treatment of choice in treating methicillin-resistant S. aureus (MRSA). Community-acquired MRSA is associated with infections in patients without recent history of hospital admission and without the classical risk factors for MRSA carriage (including healthcare personnel). MRSA poses new threats and challenges beyond the hospital with the emergence of community-acquired MRSA. Indiscriminate use of vancomycin leads to the emergence and spread of vancomycin resistance in multidrug resistant strains is of growing concern in the recent years. Minimum Inhibitory concentration (MIC) remains an important determinant in choosing the right antibiotics. Infections caused by MRSA strains with vancomycin MIC > 4 μg/mL leads to the vancomycin treatment failure. The Clinical Laboratory Standards Institute had also lowered the cut-off susceptibility and resistance breakpoints for vancomycin. Despite the availability of newer antimicrobial agents (Linezolid, Daptomycin, Tigecycline) for drug-resistant Gram-positive pathogens, clinicians and patients still need options for treatment of MRSA infection. There is a need to reduce the global burden of infections caused by Gram-positive pathogens and its resistant strains (mainly MRSA). Continuous efforts should be made to prevent the spread and the emergence of glycopeptide resistance by early detection of the resistant strains and using the proper infection control measures in the hospital setting.